Name: Benefits of the NanoScope™ System for Trauma and Fracture Management
Uploaded: 2021-02-02T00:00:00Z
Channel: Arthrex
Description: Christopher William Hodgkins, MD (Miami, FL), demonstrates the benefits of the NanoScope™ system for trauma and fracture management.

<p>Christopher William Hodgkins, MD (Miami, FL), demonstrates the benefits of the NanoScope™ system for trauma and fracture management.</p>

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VID1-001769-en-US | A | Benefits of the NanoScope™ System for Trauma and Fracture Management

Christopher Hodgkins

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Benefits of the NanoScope™ System for Trauma and Fracture Management

Chris Hodgkins from Miami. And pleasure to be here tonight to show you how I use nano arthroscopy in acute ankle fracture trauma. Now I scope almost every ankle fracture. The literature clearly shows that the rate of intra-articular injury is up to 50%, and sometimes even up to 80% in certain papers. The literature also shows that intra-articular injury, fracture reduction, and residual syndesmotic instability leads to poorer outcomes in ankle fractures and therefore, for the sake of a very quick and easy nano arthroscopy procedure, I think it's very important to scope ankle fractures. And I'd like to show you how I do that. So this is a cadaver that we already have set up. I have my patients supine on a regular table. I have a bump under the hip. I have a thigh support underneath the leg for counter traction, and I have them in a noninvasive traction device. As we see here, I prep and drape up to just beneath the knee. We already have some landmarks marked out here, but important anatomy is the tibialis anterior tendon, the most lateral structure in the anterior compartment, which is normally the peroneus tertius. And don't forget the superficial peroneal nerve. I've already established our portals here, but the anteromedial portal should be just medial to the tibialis anterior tendon. And I'll let my thumb just fall. Medial to that. And dorsiflex and plantar flex the ankle, and you'll feel your thumb fall into that kind of soft spots and dimple. You want to be very close to the tendon. Obviously avoid being too medial with the saphenous vein and nervous again laterally for the anterolateral portal. I have my thumb just fall off the peroneus tertius in the soft spots as I plan to flex and dorsiflex, and that gives me the position of the anterolateral portal. Obviously, stay away from the superficial peroneal nerve. So we've already marked this for a trauma situation. And so we filled the ankle with blood. But that makes it very difficult to visualize. And we'd like to demonstrate that to you. So I'm first going to insert my high flow high flow bent sheath with a blunt trocar. The high flow sheath allows increased flow into the ankle, so it gives you increased distention of the ankle capsule, and the bent cannula allows you more traditional camera angle visualization. So I insert this into the ankle I'm going to turn my fluid on. Thank you. And I'm going to insert my camera here. And you'll see that it's actually very difficult to see anything. Our view is obscured by blood and hematoma and debris. So we're going to stop there. I'm going to tell my fluid off. Take the camera out. And so in a trauma setting, in a regular setting, I'll normally make my anterolateral portal under direct visualization with the camera in the anteromedial portal. But in trauma, that's just not possible. And therefore, I'll make both of my portals at the same time. So now I'll take another cannula and insert it into the anterolateral portal. And then I'll turn my water on. And I'll flush the joint. Sometimes you have to jiggle these cannulas around a little bit. But you'll see nicely there that we see all the blood and fat and debris coming out of the ankle. And I'll do that until my fluid is clear. And now it's clear. And so now I will reinsert my nano. And all of a sudden you can see what we need to see. So you see the difference it makes. That's why it's so important to flush. So now I'll go to perform my regular diagnostic arthroscopy. And I use 21 point examination which begins with visualization of the deep deltoid medial gutter Gotha Anteromedial talus. I'm moving my camera here or moving my sheath so I can look to the left. Looking at my central anterior talus. Lateral anterior talus or trifurcation. Here. Atfl. And then again, I can look down into my lateral Gaza. I'll then advance my camera through the notch of Hathi and continue my diagnostic arthroscopy again, moving my sheath so I can look to the right. Looking at my central. So my medial tibiotalar articulation. Central tibiotalar articulation. Lateral tibiotalar articulation. And then the rest of the diagnostic arthroscopy obviously occurs through the posterolateral portal, which we're not going to make for the sake of time here. But obviously then examines the posterior aspect of the joint. We forgot the anterior recess, which is part of our examination of the anterior joint there as well. Now one of the important things I things I get asked was, okay, well, how do you then take everything down to then get on with fixing your ankle fracture? So I'm going to show you that because it's very important. So I take the ankle fracture, the sorry, the distraction strap off. I'll then take the entire. Traction device off the ankle. Now my hands are no longer sterile because they touch something that was beneath my waist. So I'll remove my outer gloves. And then I will just hold the leg up while I have my circulating nurse get underneath the drapes over here, remove my thigh support, which was my counter traction device. And then once she's done that, I'll pull the leg down, pull the drapes, distal riprap the leg, and then put another pair of gloves on and that completes the ankle fracture. Arthroscopy. So in summary, the advantages of nano arthroscopy and trauma. This this device has portable on the shelf plug and play capability. It's quick and it's easy for all staff at any time of the day to set up. Even I can set this up. You can use it in dry fashion, in wet fashion, and it really does have foolproof operability. It's minimally invasive, but maximally effective. You can see trees and document intra-articular pathology in all periarticular fractures, whether it's proximal humerus, elbow, wrist, knee, ankle, whatever it might be. It allows you to visualize and aid in anatomic fracture reductions. And I really believe that this is the future of comprehensive fracture care. And I think it's going to be the standard of care. And I think patients are going to demand it. And after all, it makes me a better surgeon and it helps my patients.

Benefits of the NanoScope™ System for Trauma and Fracture Management

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